Endoscopic surgical instrument



Sept. 7, 1948. w. w. SCOTT ET AL ENDOSCOPIC SURGICAL INSTRUMENT Filed April 25, 1945 5 Sheets-Sheet l Z Qmgw.

Sept. 7, 1948.

W. W. SCOTT ET AL ENDOSCOPIC SURGICAL INSTRUMENT 3 Sheets-Sheet 2 Filed April 25, 1945 il||l||| .4 4 1 a E a-m Sept. 7, 1948. w. w. sco'r'r ETAL 2,448,741

. ENDOSCOPIC SURGICAL INSTRUMENT Fii'ed April 25, 1945 asneets-szieet' 3 Patented Sept. 7, 1948 UNITED STATES PATENT OFFICE ENDOSCOPIC SURGICAL INSTRUMENT William W. Scott and August Lutz, Chicago, 111., assignors to American Cystoscope Makers, Inc., a corporation of New York Application April 25, 1945, Serial No. 590,208

8 Claims. I (O1. 128303.15)

. 1 This invention relates to endoscopic surgical instruments used for examination and surgery within the cavities of the human body. While the preferred form of the instrument described and shown in this application is designed pri-,

marily for transurethral prostatic surgery, it is readily adaptable to other uses and is not limited to that specific purpose.

. One of the objects of the invention is to provide an endoscopic surgical instrument which can be operated with greater facility and ease than similar instruments now in use and which can be more accurately located within a body cavity for use therein.

Another object of the invention is to provide quickly and securely locked together without.

tools.

1 Still another object of the invention is to provide a surgical instrument of this type which may be manipulated with one hand leaving the other hand free for auxiliary manipulation. For

example, when the instrument is used in prostatic surgery it can be operated with one hand leaving the other free for rectal palpation and third dimensional perception,

Another object of the invention is to provide an instrument of this type in which the handle or grip portion can be maintained in a stationary position while the working elements which are inserted in the body cavities can be rotated relatively to the grip portion. and operated without any change in the manipulation in a full range of positions throughout the 360 degrees of rotation available.

A further object of the invention is to provide a surgical instrument of this type with novel means of securing the reciprocal cutting electrode in the instrument so that it cannot become detached during the use of the instrument.

Another object of the invention is to provide an instrument of this type in which the liquid and electrical leads leading to the instrument may remain in a fairly constant position with respect to the operating portions of the instrument thus reducing the interference of these leads with the manipulation of the instrument in the performance of surgery. I

These and other features of the invention will be seen from the following detailed specification read in connection with the accompanying drawings formingpart thereof and in which--' Fig. 1 is an elevation of the instrument of-this invention in assembled condition ready for use;

Fig. 2 is a section through part of the grip member taken on the line 2-2 of Fig. 1;

Fig. 3 is a section through part of the grip member taken on the line 3-3 of Fig. 1;

Fig. 4 is a section through part of the grip member taken on the line 44' of Fig. 1;

Fig. 5 is a longitudinal middle section of the complete instrument shown in Fig. 1 omitting the water and electrical leads to theinstrument;

Fig. 6 is a section through part-of the gri member taken on the line 6-6 of Fig. 5; l I

Fig. '7 is a fragmentary section of the detent taken on the line of Fig. 6;

Fig. 8 is a view in perspective of the reciprocable instrument carrier for the electricalcutting loop; 1

Fig. 9 is a, fragmentary elevation in section of the proximal end of the carrier shown in Fig, 8; i i

Fig. 10 is a perspective of the distal. end of the carrier showing the electrical cutting loop, light and telescope lens; 1

Fig. 11 is an elevation of the frontend of the sheath and carrier showing various radial positions to which these parts may be turned without change in position of the grip member;

Fig. 12 is a perspective of a modified form of instrument carrier;

Fig. 13 is a perspective ofa fragment-of a second modified form of instrument carrier.

Referring to the drawings, the preferred form of the instrument herein will be described as a series of assemblies which are more or less related and which, when combined, form the completed instrument.

A. THE GRIP MEMBER Referring to Fig. 1 showing the complete assembled instrument, thenumeral 20 indicates the handle member which is generally hollowto contain the movin portions of the instrument and, if desired, may be covered with transparent plates 21 secured to the handle frame in the conventional manner. The handle 29 is preferably made of metal but may also be formed from other materials which can be suitably molded or cut into a shape which may be readily gripped by the human hand and which may be hollowed out to contain the moving parts of the instrument. 1 i Y The handle member 20 is showndivided into a rear chamber 22 and a forward chamber fl. The rear chamber has a bottom wall 25 and a top wall 21 while the forward. chamber 24 terminates in the forward wall 28..l If desired, the two chambers 22 and 24 may be separated by an intermediatewall 26 which may also be employed to carrier? serve as a support and bearing member for various parts of the instrument. The upper portion of the handle terminates in the back wall 36.

Entering into the chamber are the electrical leads 32 and 34. Lead 32 is shown as a monopolar lead for high frequency resecting and cauterizing current while lead 34 is a bipolar lead for low voltage illuminating current. These leads pass through the lower end of the grip member through the bore 36 (Fig. 5);

Secured to the back wall 30 of the rear chamber 22 are the lower insulating block 38 and the upper insulating block 42 upon which are mounted binding posts for the current leads 32 and 34. The high frequency lead binding post numbered 46 andthe illuminating current bindi g posts 1. e e post a e t i l connected with the illuminating current brushes Mounted within the grip member 20 spring-chamber 52 within which is mounted the coil' spring 54. Riding upon thespringQchamb'er 52 is the trigger sleeve 58 to which is attached .the trigger 56 which projects beyond the grip member and is reciprocable with respect thereto.

'I'he coil spring 54 bears against the trigger sleeve pin 60 which'liis connected to the trigger sleeve'SB and passes through .a slot in one side of the spring chamber 52. .The coil spring 54 thus forces the trigger back to its forward posi- -tion whenever pressure upon the triggeris'released.

Secured to the trigger is the fork 62v which projects into the forward chamber '24 tomove the instrument carrier. This fork terminates at its upper end in a series ofltines 64 which transmit the .motionfrom the trigger to the instrument C. WATER Lean Entering-into the front wau .28 or. the handle D. INSTRUMENT CARRIER ROTATOR ASSEMBLY.

Referring to Fig. 5, there is mounted within the wall 28 the carrier bearing sleeve I6 which is drilled with a bore to connect with the water inlet tube I4 and forms a journal for the forward carrier bearing I8 which is also suitably bored and grooved to permit the flow of liquid from the inlet tube I4 forward into the operating instrument but is so closely fitted as to prevent the flow of liquid into the compartments of the handle member 20'. ing is'the carrier rotating pinion or driving gear At the rear end of the carrier bear- 80 and secured to the forward end of the carrier bearing. is the carrier rotating wheel 82 which is (suitably knurled or serrated to permit its ready manipulation by the finger. In order to prevent undesired rotation of the rotating wheel 82 the face of the wheel may be provided with detentseats 84. These may be radially arranged on the rotating wheel so as to pass before the detent tube 86 (Fig. 6) within which is contained the detent spring 88 and the detent ball 90 designed to seat in the detent seats 84.

Directly forward of the rotating wheel 82 is the sheath nipple 92 which may be provided with a suitable latch 94 to secure the sheath to the grip portion of the instrument.

E. INSTRUMENT CARRIER AND Rrzcrraocarox ASSEMBLY Rotatably mounted within the forward chamber 24 is the instrument carrier or working member I02 which is snugly fitted in the forward carrier bearing I8 and may be further supported by the rear bearing I64 mounted in the wall 26. Secured to the instrumentcarrier .162 :'is the-instrument carrier. driven pinion-IIl6 whichjs lembraced by the trigger-fork tines 64 bicwhiohthe instrument carrier is reciprocated:-.upon;move ment of the trigger 56.. Also suitablyt-journaled within the forward chamber 24. istthefiintermfzdiate gear I08 which sisenmeshed. bothqbyrthe carrier rotating pinion. andthebinstrument carrier driven pinion I66. fl'hegintermediate gear I68 is elongated so that as the driven pinion I06 moves with the reciprocating instrument carrier I62, the engagement of. the. threei.gears;;8fl, I08, and I06 remainsundisturbed. 1.1.:

At the rear end of theinstrument carrier ;I.II2 is mounted the cutting .,currentocommutator -.I I6 which bears the cutting currentbrushj I2; Hus b'rushlII2 remains in contact with-: -the cuttin current bus bar 48 as. the instrumentcarriErcIM is reciprocated. -15; The commutator II II is mountedupont'theucarrier insulating block II4 through whichare out thebtelescope bore and 'keyway I I5 and the cutting loop shank bore I I1. Thelatter is not cylindrical in form but has a fiattenedportion to fix the radial position or the cutting loop shank when inserted therein. Also mounted on the carrier insulating block I I4 is the cutting current contact II6 designed to form "a oontact for the cutting current electrode. a v

I 'At the rear of the-carrier insulating block II 4 1 is pivotally mounted the cutting loop shank latch I Iii-which pivots upon the latch pivot{I20.="-Thls latch, as best shown in Figs. 3, 8 and-9,ha s one straight edge which, when the pivotis; swung across the face of'the carrier insulating-block, partially crosses the cutting loop shank bore' I H.

The reciprocable instrument carrier I62 terminates at'its forward end in the tubes I22 and I24, the first of which is a telescope tube in whichthe telescope and illuminating shaft ismounted and the sec-0nd of which, I24, is a tube forthe cutting loop shank (Figs. 5, 8 and 10). e

The tube for the telescope shaft must permit movement of the shaft within the tube as the tube is reciprocated with the instrument carrier in the preferred embodiment 'shown herein-while the telescope and illuminating device remains in fixed position with respect to the grip portion of the instrument although it necessarilyrotates with the instrument carrier.

'Inorder to permitready sterilization of the instrumentcarrier, its body I02 mayvbe'cut with a plurality of slots I06 to give quick access of sterilizing liquid to the interior.

F. SHEATH Detachably mounted upon the sheath nipple 92 is the sheath I32 which is designed for inseroperation is to be performed. The proximal end of this sheath bears the sheath shield I34 and the sheath mounting sleeve I36 which passes over the sheath nipple 92 and may be latched thereto by means of the latch key I38 which may be any conventional form. The distal end of the sheath is preferably cut away, as shown in Fig. 1, to expose the illuminating and cutting loopfor access to the portion of the body under examination or operation. A

If desired the sheath may be provided with a water intake similar to 14 entering upon. the sheath mounting sleeve I36, or the intake may be mounted upon the sleeve I36.

The sheath is either made wholly of insulating material or is suitably insulated so that if it is engaged by the high frequency cutting loop it will not provide contact for electrical currents with the tissues with which the sheath is normally in contact. i

G. HIGH FREQUENCYCUTTING ELECTRODE The portion of the instrumentby which surgery is performed is the high frequency electrode made. up of the cutting loop shank I52, designed to be removably mounted within the cutting loop shank tube I24. This cutting loop shank I52 contains the insulator sleeve I56 through which passes the high frequency conductor I54. This conductor terminates in the cutting loop I58 which is insulated except for the bared loop portion designed to perform the resection or cautery. The cutting loop is supported by the cutting loop arms I60.

At the proximal end of the cutting loop shank I52 the high frequency conductor I54 is exposed so as to contact the cutting current contact H6. The shank I52 is also notched by the locking notch I62 designed to be engaged by thecutting loop shank latch I I B and to be. disengaged when the latch is swung upon its pivot I20. The shank is also flattened on one side to insure its correct radial position with respect to the instrument carrier I02 and sheath I32. I

H. TELESCOPE AND ILLUMINATOR Removably mounted within the telescope tube I 22 is the telescope shank I12 which passes through practically the full length of the instrument. This tube terminates in the light socket I16 in which is removably mounted a light bulb I18 and also carries the objective lens H4. The proximal end of the telescope shank terminates in the eye piece I80. Between the eye piece and the objective lens I14 and within the telescope shank is mounted a conventional lens system to permit the telescopic observation through the eye piece and objective lensof areas in proximity to the lens and within the illuminating range of the light bulb I18. 7

A portion of the telescope shank passing through the rear chamber 22 is provided with a telescope shank key I82 which is designed to fix the telescope with respect to the instrument carrier so that the objective lens I14 is always aligned with the cut away portion of the sheath I32. This shank key passes through the cutting loop shank latch H8 and the carrier insulating block I I4 and thus immovably locatesthe cutting loop shank latch which is pivoted with respect to the carrier insulating block and the electrode shank when the instrument is assembled.

Shortly forward of the eye piece I80 is the commutator block I 84 mounted upon the telescope shank. This commutator block bears an outer commutator ring I86 and an innercommutator ring I which provide the contacts for the respective-leads to the light bulb I18. When the instrument is assembled these rings bear against the brushes 46.

The commutator block is also cut with an,

annular groove I90 which is designed for engagementwith the telescope shank keeper I92 which I. MODIFICATIONS In'Figs. '12 and 13 are shown two modified forms of-the instrument carrier and reciprocator assemblywhich differ from the preferred form described merely in the manner in which rotary motion is transmitted to the instrument carrier from the-rotating wheel. In Fig. 12 the instrument carrier or working member 202 is shown without any driven pinion but with the carrier body slotted with the longitudinal keyways 208 which are snugly engaged with keys cut into the forward carrier bearing 218. The carrier is also provided with an annular flange 206 in the place of the driven pinion. This flange is embraced by the tines or fork on the trigger to reciprocate the carrier. i

- i The forward carrier bearing 218 is mounted within the sleeve 216 in the same manner in which the other forms are constructed.

In the modification shown in Fig. 13 the inst'rument carrier or working member 302 is cut into a square shaft where it passes through the and described in the specification are eliminated.

Method of assembly This instrument will normally be disassembled in part for sterilization and checking before each use. In disassembled condition the sheath I32 will be off the instrument, the telescope and illuminating assembly will be removed therefrom and thehigh frequency cutting loop will be removed from its mounting. With the instrument in this condition it is assembled for use by insertion of the cutting loop shank I52 into its tube I24 from the distal end of the instrument. The shank of the cutting loop is forced to its most rearward position through the carrier insulating block II 4 and with the conductor I54 forced snugly into contact with the cutting current contact II8 to provide a certain electrical connection. Because of the flattened end of the cutting loop shank I52 the cutting loop will always be located in a fixed position with respect to the cutting loop carrier and thus'alignment of the loop within'the cut away portion of the sheath I 32 determined.

The cutting loop shank latch I I8 is thenswung on its pivot I20 and an edge of the cutting loop shank engagesv the locking notch I62 in the shank and thus prevents the loop shank I52 from being withdrawn from the instrument carrier I02 This also insures thatwhen the loop is arr-sari recipro ates in surgical "it "wiir'iitt te" attidentally withdrawn from the instrument:

me look the cutting" loo 'shanklatchHf in position and thus" positively prevnt'grelease' of the cutting loop shank, the telescope shank ln bearing the 'illuminating' aoparatus'ana lens system is inserted through thecarrieilifiulatin block II4, carrier I02, "and telescope tube I22 from the proximal end of the instrument; The

radial position of the telescope is determined by thekey I82" o'n' meteis epe"shaa wiiien ls keyed both with 'resp cttojthe"iatcnilla and insulating block 'I I4. This insures that the telescope objective lens II4' will always be properly positioned with respect to the cutting loop I58 and the open portion of the sheath I32.

'As the telescope is forcedinto its final'position the commutator ringsv I86 and .I88..are1,brought .into contact withthe brushes 46i'to complete the to the instrument by means of an obdurator which is withdrawn after the sheath has been'properly located. The instrument may. then. be inserted into the sheath and because: of theloca'tion of the sheath 1atch 94 on the sheath nipplei92, which is fixed with respect to the radial position .of the telescope shank andthe cuttingloopshank, the open portion at the distal end of the sheath will be .properly positioned withiirespect to these devices.

Method of operation practice the sheath With the instrument inserted in the sheath to the tissues to be cutor cauterized. I Ifliquid is desired within the'body cavity-this may be run into the sheath through the lead I2 and will be held against discharge 'bymeans of the sheath shield I34 or the engagement of the body tissues about the sheath I32, depending upon 2 the extent of insertion of ;-the sheath.

The operator grasps the instrument bymeans of the grip portion 20 and placesthe forefinger, whether right or left hand, into the trigger 56. With the electrical connections established the flow of current is controlled by means 'of' switches which are conventional accessories in this art and form no part of this invention. By means of a suitable switch the light bulb I18 is lighted and the interior of the cavity can be observed through the eye piece I80.

Thereupon the high frequency current may be run through the cutting loop and the loop reciprocated by means of the trigger 56, to cut an elongated portion from the tissue in contact with the cutting loop. As the tissue is cut away and of the cutting loop, the carrier rotating wheel ma be turned'in, either direction and all of the tissue adjacent to the distal end of the sheath thus brought within reach 'of the cutting loop without any alteration of the radial position of the grip portion. I v

In the preferred embodiment shown, movement of the trlgger56 reciprocates the instrument carrier I02 with the telescope tube I22 and the cutting loop shank tube I24, thus moving the cutting loop through its path but not imparting'corresponding reciprocation to the telescope :objective lens I14 and the lightbulb I18; since: the shank I12 uponwhich theseare mounted slides freely within the telescope tube I22. If desired the instrument can be modified so that the objective lens andlight-bulb also reciprocate with the instrument carrier but this would require a reconstruction of the commutator and brushes for the illuminating circuit.

Naturally, in the manipulation of the instrument the grip" portion will be swung upward, downward or laterally in order to press the cutting loop into contact with exposed tissue but the design of this instrument avoids the necessity for turning the grip portion from its fixed position, thus leaving the hand in a normal andfairly' stationary position throughout the operation.

Because of the relative rotatability of the working position of the instrument and the grip'portion, the water and electrical leads remain'in fixed position and do not interfere'withthe operation of the instrument as they do when it is necessary to invert the handle or twist'it into urethral access to the prostaticgland but'jread- -ilypermits the resection of the dorsal ventral and lateral portion of the gland by rotation" of the sheath and the working elements of the instrument without any disturbance of the position of the grip or handle portion of the instrument. This. eliminates a great deal of the change in position required of the surgeon where the entire instrument must be rotated into various radial-positions and also maintains the water and electrical leads in a fairly constant position where they least interfere with the sur'geon. Similarly, since the instrument can be wholly manipulated by one hand, the other hand is left free for third dimensional perception and rectal palpation.

The instrument with its working member I02 can readily be withdrawn from the sheath at any time by unlatching the sheath from the sheath nipple whereupon the entire instrument, with the exception of the sheath, can be removed from the situs of the operation. I

At any time the telescope can be removed merely by loosening the keeper screw I94jand lifting the telescope shank keeper and withdrawing the telescope shank from the instrument. As the telescope shank is withdrawn, the con- 9. nectionsor the electrical illuminating system are automatically broken and a .difierent type oi -telescope :can readily be substituted for that "last usedin the instrument. f

If a different type of cutting loop is desired the instrument may be withdrawn fromthe sheath during ,the operation, the cutting loop shank unlocked by removing the telescope shank, swinging -.the cutting loop shank latch H8 and withdrawing the ,cutting loop shankfromits tube I 24 and substituting another therefor.

The method of disassembly is substantially a reversal of the assembly of the instrument and need not be further described.

Having thus shown and described three embodiments of the invention, it is to be understood that it is capable of many modifications. Changes, therefore, in the construction and arrangement may be made without departing from the spirit and scope of the invention as disclosed in the appended claims, in which it is intended to claim all novelty inherent in the invention as broadly as permissible, in view of the prior art.

What we claim is:

1. A surgical instrument comprising a grip member, an instrument carrier mounted thereon, a cutting electrode mounted upon the instrument carrier, a latch mounted upon the instrument carrier to engage the cutting electrode and lock it to the instrument carrier, and a viewing tube removably mounted on the instrument carrier and engaging the latch to prevent its movement to unlocking position.

2. A surgical instrument comprising a grip member, an instrument carrier mounted thereon, a cutting electrode mounted upon the instrument carrier, a latch mounted upon the instrument carrier to engage the cutting electrode and lock it to the instrument carrier, a viewing tube removably mounted on the instrument carrier and engaging the latch to prevent its movement to unlocking position, an electrical contact upon the instrument carrier engageable by the electrode for passage of a high frequency current therethrough, and a pair of electrical contacts upon the grip member to engage complementary contacts upon the viewing tube when the viewing tube is mounted upon the instrument carrier.

3. A surgical instrument comprising a grip member, an instrument carrier mounted thereon, a cutting electrode mounted upon the instrument carrier, a latch mounted upon the nstrument carrier to engage the cutting electrode and lock it to the instrument carrier, a viewing tube removably mounted on the instrument carrier and engaging the latch to prevent its movement to unlocking position, an electrical contact upon the instrument carrier engageable by the electrode for passage of a high frequency current therethrough, a pair of electrical contacts upon the grip member to engage complementary contacts upon the viewing tube when the viewing tube is mounted upon the instrument carrier, and means upon the grip member to engage the viewing tube to secure it against longitudinal motion with respect to the instrument carrier and grip member.

4. A surgical instrument comprising a grip member, an instrument carrier rotatably and reciprocally mounted therein, a rotating wheel mounted upon the grip member to rotate the instrument carrier, a sheath for insertion into a body cavity mounted upon the rotating wheel and rotatable therewith, a cutting electrode mounted upon the instrument carrier and movable therewith, a latch mounted upon the instrument car'rierto engage the electrode and secure it to the instrument {carrier against longitudinal carrier and rotatable therewith and engaging the latch .to prevent its movement to unlocking" position, a .pair .of commutator: rings upon the viewing tube, a pair of complementary contacts upon the grip member, means upon the grip member to latch the viewing tube in position, and means upon the grip member to reciprocate the instrument carrier and the electrode therewith.

5. A surgical instrument comprising a grip member, an instrument carrier rotatably and reciprocably mounted upon the grip member, a cutting electrode removably secured to the instrument carrier and rotatable and reciprocable therewith, a telescope secured to and rotatable with the instrument carrier, means carried by the grip member for imparting reciprocation to the instrument carrier, and means carried by the grip member for imparting rotation to the instrument carrier with respect to the grip member through 360.

6. A surgical instrument comprising a grip member, an instrument carrier rotatably and reciprocably mounted upon the grip member, a cutting electrode removably secured to the instrument carrier and rotatable and reciprocable therewith, a telescope secured to and rotatable with the instrument carrier, means carried by the grip member for imparting reciprocation to the instrument carrier, and means carried by the grip member including a wheel rotatable about an axis substantially coincident with the axis of the instrument carrier for imparting rotation to the instrument carrier with respect to the grip member through 360.

'7. A surgical instrument comprising a grip member, an instrument carrier rotatably and reciprocably mounted upon the grip member, a cutting electrode removably secured to the instrument carrier and rotatable and reciprocable therewith, a telescope secured to and rotatable with the instrument carrier, a sheath mounted on the grip member and rotatable with the instrument carrier, said sheath encircling the cutting electrode and the telescope, means carried by the grip member for imparting reciprocation to the instrument carrier, and means carried by the grip member for impartin rotation to the instrument carrier and the sheath with respect to the grip member through 360.

8. A surgical instrument comprising a grip member, an instrument carrier rotatably and reciprocably mounted upon the grip member, a cutting electrode removably secured to the instrument carrier and rotatable andreciprocable therewith, a telescope secured to and rotatable with the instrument carrier, a sheath mounted on the grip member, said sheath being substantially coaxial and rotatable with the instrument carrier and encircling the cutting electrode and the telescope, means carried by the grip member for imparting reciprocation to the instrument carrier, and means carried by the grip member includin a wheel rotatable about an axis substantially coincident with the axis of the instrument carrier for imparting rotation to the in- 11 12 strument carrier and the sheath with respect to Number, I Name f L Date the gri m mber through 3 0. 1,679,950 Stern Aug. 7; 1928 WILLIAM W. SCOTT. 1,971,024 Wappler' Aug. 21, 1934 1 AUGUST T 1,798,902 Raney Mar. 31, 1931 5 2,090,923 W'appler Aug. 24,1937 REFERENCES CITED 1,908,201. Welch et a1. May 9, 1933 The following references are of record in the I dTHER REFERENCES file of this patent:

Natiohallnstruments pamphlet of National UNITED STATES PATENTS 1 Electric Instrument 00., Long Island City, N. Y.',

Numleer Name Date Nov. 1937, page 4.

2,031,020 Wappler Feb. 18, 1936 V 

